Idiopathic Bone Cavity: Clinicopathologic Features from a Case Series with Emphasis on Differential Diagnosis of Chronic Apical Periodontitis.

INTRODUCTION: Idiopathic bone cavity (IBC) is an uncommon bone lesion that usually affects youngsters as an unilocular radiolucency with predilection for the posterior mandible. Because the lesion is frequently located in proximity to the adjacent teeth, chronic apical periodontitis is commonly included as a differential diagnosis. The aim of the present study was to analyze the clinical and radiologic features of a series of IBCs diagnosed in a single service. METHODS: All cases diagnosed as IBC were retrieved from the files of an oral pathology laboratory, and the clinical and radiologic characteristics were described with a focus on the differential diagnosis with chronic apical periodontitis. RESULTS: Thirty cases composed the final sample. The mean age of the affected patients was 22 years old; there was no sex predilection, and most lesions were located on the posterior (47%) and anterior (43%) mandible. Most lesions presented as unilocular radiolucencies (87%), and 90% were located in close association with the adjacent teeth. The associated teeth presented no endodontic involvement, and all proved to be vital. CONCLUSIONS: IBC usually affects young patients as an unilocular radiolucency in close association with the adjacent teeth. Careful radiologic analysis and vitality tests of the adjacent teeth are essential to rule out chronic apical periodontitis, thus avoiding any unnecessary endodontic treatment.

Increased Root Canal Endotoxin Levels are Associated with Chronic Apical Periodontitis, Increased Oxidative and Nitrosative Stress, Major Depression, Severity of Depression, and a Lowered Quality of Life.

Evidence indicates that major depression is accompanied by increased translocation of gut commensal Gram-negative bacteria (leaky gut) and consequent activation of oxidative and nitrosative (O&NS) pathways. This present study examined the associations among chronic apical periodontitis (CAP), root canal endotoxin levels (lipopolysaccharides, LPS), O&NS pathways, depressive symptoms, and quality of life. Measurements included advanced oxidation protein products (AOPP), nitric oxide metabolites (NOx), lipid peroxides (LOOH), -sulfhydryl (SH) groups, total radical trapping antioxidant parameter (TRAP), and paraoxonase (PON)1 activity in participants with CAP, with and without depression, as well as healthy controls (no depression, no CAP). Root canal LPS levels were positively associated with CAP, clinical depression, severity of depression (as measured with the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory) and O&NS biomarkers, especially NOx and TRAP. CAP-related depression was accompanied by increased levels of NOx, LOOH, AOPP, and TRAP. In CAP participants, there was a strong correlation (r = 0.734, p < 0.001) between root canal LPS and the HDRS score. There were significant and positive associations between CAP or root canal endotoxin with the vegetative and physio-somatic symptoms of the HDRS as well as a significant inverse association between root canal endotoxin and quality of life with strong effects on psychological, environmental, and social domains. It is concluded that increased root canal LPS accompanying CAP may cause depression and a lowered quality of life, which may be partly explained by activated O&NS pathways, especially NOx thereby enhancing hypernitrosylation and thus neuroprogressive processes. Dental health and "leaky teeth" may be intimately linked to the etiology and course of depression, while significantly impacting quality of life.

Cellular Profile and Expression of Immunologic Markers in Chronic Apical Periodontitis from HIV-infected Patients Undergoing Highly Active Antiretroviral Therapy.

INTRODUCTION: This study tested the hypothesis that the inflammatory cell profile (CD3-, CD4-, CD8-, CD20-, and CD68-positive cells) and the expression of immunologic markers (tumor necrosis factor α, interferon-γ, interleukin-6, and interleukin-18) in chronic apical periodontitis are the same between non-HIV-infected patients and HIV-infected patients undergoing highly active antiretroviral therapy (HAART). METHODS: Thirty-four surgically excised chronic apical periodontitis lesions were sampled from 34 patients (17 HIV-infected and 17 non-HIV-infected). The lesions were extracted from teeth with no previous endodontic treatment. All HIV-infected patients were undergoing HAART. The specimens were submitted to histopathologic and immunohistochemical analyses by using an optical microscope. Immunoexpression was graded into 2 levels, focal to weak and moderate to strong. The χ(2), Fisher exact, and Mann-Whitney tests were used to analyze all significant differences between groups. RESULTS: Periapical cysts represented 70.6% and 52.9% of the lesions in the HIV-infected and non-HIV-infected groups, respectively; however, no statistically significant difference was observed (P = .481). There were no statistically significant differences between groups for the inflammatory cell profile and for any of the immunologic markers (P > .05). CONCLUSIONS: There are no statistically significant differences of the cellular profile and expression of immunologic markers in chronic apical periodontitis between non-HIV-infected patients and HIV-infected patients undergoing HAART.

Sucesso da cirurgia perirradicular na resolução de infecção endodôntica persistente com controle tomográfico de 2 anos / Success of periradicular surgery in persistent endodontic infection resolution with CT control of 2 years

O presente relato de caso tem como objetivo descrever e discutir o tratamento de um dente incisivo central superior direito tratado endodonticamente, com presença de reabsorção radicular apical e radiolucencia periapical. Ao exame clínico a paciente se encontrava com fístula na região apical da mucosa vestibular do referido dente. Ao exame por imagens a radiografia periapical e tomografia computadorizada conebeam, revelaram a presença de área radiolúcida no terço apical, dentro do canal radicular, inacessível aos procedimentos do preparo químico-mecânico tornado o retratamento endodôntico incerto. Dessa forma, a cirurgia perirradicular foi a terapêutica instituída, com a realização da apicectomia, retropreparo e retrobturação do canal radicular, com uso de insertos ultrassônicos apropriados e do Agregado Trióxido Mineral (MTA), respectivamente. Após dois anos de proservação pôde-se observar o controle da infecção endodôntica. O tratamento foi considerado um sucesso, visto que a paciente se encontrava assintomática, com ausência de fístula e com regressão completa da radiolucência periapical e neoformação ãssea. Pode-se concluir que a cirurgia perirradicular apresentou-se como um tratamento eficaz para a resolução do referido caso clínico, possibilitando um grau de desinfecção compatível com a cura perirradicular para o paciente... (AU)

This case report aims to describe and discuss the treatment of a right maxillary central incisor tooth, endodontically treated, with presence of an internal root resorption and periradicular radiolucency. On clinical examination the patient presented a sinus tract at the apical buccal mucosa of this tooth. The periapical radiograph and cone beam computed tomography detected the presence of radiolucent area inside root canal (apical third). This area showed to be inaccessible to adequate chemical-mechanical preparation, so, the endodontic retreatment would give an uncertain prognosis. Thus, the periradicular surgery was the indicated therapy for this case, including apicectomy, retropreparation and root canal retrofilling, with the use of appropriated ultrasonic inserts and Mineral trioxide aggregate (MTA), respectively. After two years of follow-up, the endodontic infection control was observed. The treatment was considered a success, as the patient was asymptomatic, with no sinus tract and with complete regression of periapical radiolucency and bone formation. It can be concluded that the periradicular surgery was an effective treatment for the patient, allowing a degree of disinfection compatible with periradicular cure... (AU)

Prevalencia de periodontitis apical crónica en dientes tratadosendodónticamente en la comunidad académica de la Universidad Cooperativa de Colombia, Pasto, 2008 / Prevalence of chronic apical periodontitis in endodontically treated teeth in the academic community at Universidad Cooperativa de Colombia, Pasto, 2008

Introducción: determinar la prevalencia de periodontitis apical crónica en dientes tratados endodónticamente en lacomunidad académica de la Universidad Cooperativa de Colombia, Pasto. Métodos: se diseñó un estudio transversal, en donde se incluyeron 37 personas y 49 dientes tratados endodónticamente. Estos fueron evaluados por dos examinadores para determinar la prevalencia de periodontitis apical crónica y variables relacionadas como edad, sexo, dientes, calidad del tratamiento de conducto,caries dental, tipo y calidad de la restauración. El índice de Kappa de Cohen interexaminador fue tomado. Resultados: periodontitis apical crónica (PAC) fue evidente en 79,6% de todos los dientes con tratamiento de conducto. De estos 56,4% pertenecieron ahombres y 43,6% a mujeres. Los dientes premolares obturados tuvieron prevalencia de PAC mayor a molares. De acuerdo con el sellado de las obturaciones, solamente el 24,3% con sellado adecuado no tenía periodontitis apical. El 12,2% de los dientesobturados fueron considerados adecuados técnicamente. Dientes restaurados con resina tuvieron PAC más severa. Conclusiones: este estudio determinó que en esta población hay alta prevalencia de periodontitis apical crónica. Variables como género, tipo dediente, calidad del tratamiento de conducto, caries dental y calidad de la restauración influyen sobre la presencia de PAC.

Introduction: to determine the prevalence of chronic apical periodontitis in endodontically treated teeth in the academic community at Universidad Cooperativa de Colombia, Pasto. Methods: a cross-sectional study was designed where a sample of 37 individuals and 49 endodontically treated teeth were included. They were screened by two examiners to determinethe prevalence of chronic apical periodontitis and related variables such as age, gender, teeth, quality of endodontic filling, dental caries, and type and quality of restoration. Inter-examiner Cohen’s Kappa index was done. Results: chronic apical periodontitis (CAP) was evident in 79.6% of all endodontic treated teeth. Of teeth with CAP, 56.4% belonged to men and 43.6% to women. Premolars had a greater prevalence of chronic apical periodontitis than molars. According to endodontic fillings seal, only 24.3% with adequate seal did not have chronic apical periodontitis. The 12.2% of the endodontically treated teeth were considered technically adequate. Teeth restored with composite had severe CAP. Conclusions: this study determined that in this population there is a high prevalence of chronic apical periodontitis. Variables such as gender, type of tooth, root filling quality, dental caries and restoration quality influence the CAP presence.

Analysis of Enterococcus faecalis in samples from Turkish patients with primary endodontic infections and failed endodontic treatment by real-time PCR SYBR green method

OBJECTIVE: The aims of this study were to investigate the presence of Enterococcus faecalis in primary endodontic infections and failed endodontic treatments using real-time PCR and to determine the statistical importance of the presence of E. faecalis in a Turkish population with endodontic infections. MATERIAL AND METHODS: E. faecalis was investigated from 79 microbial samples collected from patients who were treated at the Endodontic Clinic of the Dental School of Atatürk University (Erzurum, Turkey). Microbial samples were taken from 43 patients (Group 1) with failed endodontic treatments and 36 patients (Group 2) with chronic apical periodontitis (primary endodontic infections). DNA was extracted from the samples by using a QIAamp® DNA mini-kit and analyzed with real-time PCR SYBR Green. RESULTS: E. faecalis was detected in 41 out of 79 patients, suggesting that it exists in not less than 61 percent of all endodontic infections when the proportion test (z= -1.645,

Prevalência de periodontite apical crônica (PAC) em pacientes idosos atendidos nas clínicas de graduação da FOP, UFPE e FOR / Prevalence of chronic apical periodontites in elderly patients taken care at graduation clinics of FOP, UFPE and FOR

Esta pesquisa foi realizada em 32 pacientes acima de 60 anos de idade atendidos nas clínicas de Semiologia, Prótese Dentárias e Clínica Integrada da graduação das Faculdades de Odontologia da UPE, UFPE e FOR, com o objetivo de avaliar a prevalência de Periodontite Apical Crônica (P.A.C.)nestes idosos através de axames radiográficos correlacionando esses achados com fatores como: idade, gênero, escolaridade, dente mais acometido, número de dentes presentes na cavidade oral e estado geral do paciente. A presença da P.A.C. foi confirmada em apenas cinco (15,6%) idosos, portanto a prevalência da lesão foi considerada baixa, mesmo levando em consideração a pequena amostra; a presença da mesma foi registrada em 8 dentes, destes pacientes destaca-se que: quatro era do sexo feminino, com idades variando entre 61 a 69 anos, sendo que três tinham 67 anos; todos tinham hipertensão arterial; em relação à escolaridade registrou-se que um paciente era analfabeto, um tinha primeiro grau incompleto e três tinham 1º grau completo.

This study done on 32 pacients 60 years odl and over, who received care at the clinics of semiology, prosthodontics, and integrated clinic of graduation of the dentistry scholls of UPE, ufpe, and FOR, with the purpose of evaluating the prevalence of Chronic Apical Periodontitis on these people of age through radiographic examinations, correlating these findings with factors such as: age, gender, level of education, more tooth, number of teeth present in the oral cavity, and overall state of the pacient. The presence of Chronic Apical Periodontitis was confirmed on only 5 (15.6%) pacients, wich was a low prevalence of the lesion; the presence of the same was registered in 8 teeth, of these pacients it is notable that: 4 were females, with age varying from 61 to 69 years, with 3 being 67 years old; each one had arterial hypertension; in relation to level of education, it was noted that 1 pacient was illiterate.

The importance of radiographic diagnosis of incipient occlusal caries: case report / A importância do diagnóstico radiográfico de cárie oclusal incipiente: relato de caso

The treatment of a large dentine caries, which seemed to be a small pit-and-fissure carious lesion on the occlusal surface of the permanent mandibular right first molar in a 6-year-old boy, is presented. The treatment included the filling of the root canals and the sealing of the cavity with composite resin. Underlying periodontal tissue healing could be radiographically observed at the 14-month follow-up. It is possible that a better visual examination, with careful cleaning and drying of teeth, may improve occlusal caries detection. Dentists should examine bitewing radiographies carefully for occlusal demineralization. As radiographies are probably an effective method of lesions caries diagnosis, they should be recommended at appropriate ages to aid early detection of these lesions.

O tratamento de uma cárie grande do dentine, que pareça ser um lesion carious do poço-e-pit-and-fissure pequeno na superfície occlusal do primeiro molar da direita mandibular permanente em um menino de 6-year-old, é apresentado. O tratamento inclui o enchimento dos canais da raiz e do sealing da cavidade com resina composta. O tecido peridental subjacente que healing podia radiographically ser observado na continuação de 14 mês. É possível que uma examinação visual melhor, com limpeza cuidadosa e secagem dos dentes, pode melhorar a deteção occlusal da cárie. Os dentistas devem examinar radiographies do bitewing com cuidado para o demineralization occlusal. Porque as radiografias são provavelmente um método eficaz do diagnóstico da cárie dos lesions, devem ser recomendados em idades apropriadas ajudar à deteção adiantada desta lesão.

Chronic apical periodentitis in patient with bilateral Sturge-Weber syndrome: report of a case / Periodontite apical crônica em paciente com sindrome de Sturge-Weber bilateral: relato de caso

This syndrome, also known as encephalotrigeminal angiomatosis, is a condition which includes vascular anomalies and intra-oral involvement. A patient came to the Dentistry School's endodontic clinic with complaints of localized pain on the lateral superior left teeth. She had a previous diagnostic of Sturge-Weber syndrome confirmed by the presence of bilateral facial nevus flammeus, examinations of angiography, radiological evidence of calcific densities, and ipsilaterally intra-oral vascular hyperplasia in the lip, cheek and tongue. Dental management included plaque control instructions, root planing and dental restoration. Particular attention is given to oral clinical changes, there were no complications and the tissue healed normally.

Esta síndrome, também conhecida como angiomatose encéfalo trigeminal, é uma condição que inclui anormalidades vasculares e envolvimento intra-oral. Um paciente procurou à Clínica de Endodontia da Faculdade de Odontologia de Pernambuco com queixa de dor localizada no dente incisivo lateral superior. A paciente já possuia diagnóstico prévio da síndrome de Sturge-Weber confirmado pela presença de nevos flâmeos localizados bilateralmente na fse, angiografias, evidencias radiológicas de calcificações, e hiperplasia vascular ipsilateral do lábio, língua e região jugal. O tratamento odontológico incluiu instruções para controle de placa, tratamento endodôntico e restaurações dentária. Acompanhamento pós-operatório foi realizado cuidadosamente e a cura ocorreu sem complicações.